Development and piloting of One Health curriculum in Jordan.

Background: In Jordan, several steps have been done to implement One Health (OH) approach. To increase the awareness for OH concept and approach among health professionals, there was an apparent need to develop an OH curriculum or package to orientate human, animal, and environmental health officials and professionals. Aim: The aim of this study was to describe the development and piloting of a OH curriculum for human, animal, and environmental officials and professionals in Jordan. Methods: OH curriculum was developed and consisted of four chapters/sections, each of which contained series of power point presentations that covered subject thoroughly and met the learning objectives for each section. Four day workshops on OH curriculum were done for four cohorts of participants from different OH partners. Each section started and ended with a quick knowledge assessment consisting of multiple choice questions (MCQs) (pre- and post-chapter). Comparison of the pre- and post-chapter knowledge assessment scores/results were used to assess gain of knowledge after each section of OH curriculum was completed. The scores of correct answers were compared within the different cohorts using Pearson's chi-square test with p-values ≤0.05 considered significant. Results: Of the total attendance, pre- and post- training quizzes were scored for 102 participants (816 quizzes). Pre-training scores for the different cohorts ranged from 29% to 36%, while post-training scores for the different cohorts ranged from 80% to 87%. Post-training correct answers scores were significantly higher than those were for pre-training scores for the different cohorts (p < 0.05). Percentage of knowledge gain ranged from 41% to 62% for the first section, 34% to 47% for the second section, 41% to 55% for the second section, and 48% to 60% for the fourth section. Average percentage of knowledge gain for the first, second, third, and fourth cohorts were 51%, 53%, 47%, and 47%, respectively, and was 50% for all cohorts. Conclusion: The developed OH curriculum improved different OH partners and officials understanding of the OH concept and approach.

Implementation of one health approach in Jordan: Joint risk assessment of rabies and avian influenza utilizing the tripartite operational tool.

Background Health challenges at the human-animal-environment interface vary and include zoonotic and food-borne diseases as well as antimicrobial resistance. These are serious threats to animal and public health, and account for the majority of emerging and re-emerging conditions or infectious diseases. Reducing zoonotic disease threats requires an understanding of where and why risks exist. To support countries in building multi-sectoral mechanisms to jointly assess the risks at the human-animal-environment interface, a new operational tool is available to complement the existing tripartite guide to addressing zoonotic diseases in countries. The aim of this study is to conduct joint risk assessment (JRA) of rabies and avian influenza in Jordan utilizing the tripartite Joint Risk Assessment Operational Tool (JRA OT). Methods Representatives of sectors that are involved in zoonotic diseases outbreak investigation, control, surveillance and risk assessment, were trained on JRA OT. The operational tool of tripartite guide to addressing zoonotic diseases in countries that was developed by WHO (World Health Organization), FAO (Food and Agriculture Organization of the United Nations) and WOAH (World Organization for Animal Health) was utilized to conduct risk assessment for rabies and H5N1 avian influenza in Jordan. Results The risk assessment outcome for rabies were as follows: Likelihood is high; impact is moderate with moderate level of uncertainty. The impact of the disease is moderate because the virus transmitted only by animal bite in Jordan. The level of uncertainty is moderate due to existence of some gaps in data available from the ministries regarding the surveillance and collection areas of wild animals with feral dogs. The risk assessment outcome for H5N1 AI indicated a low likelihood estimate with moderate uncertainty level. The impact estimate for H5N1 AI in Jordan is moderate with a low level of uncertainty. Conclusions The tripartite JRA OT provides a helpful and easy to follow guide to bring together expertise and information from all relevant sectors to jointly assess risks from zoonotic diseases and contributes to the understanding and management of shared threats at the human-animal-environment interface.

Implementation of One Health approach in Jordan: Review and mapping of ministerial mechanisms of zoonotic disease reporting and control, and inter-sectoral collaboration.

Background: Mapping across relevant sectors builds an understanding of a successful multi-sectoral One Health approach. This requires a review and understanding of existing national infrastructure, capacity, resources, and existing mechanisms for collaboration across sectors for addressing zoonotic diseases. The objective of this study is to review and map the existing structures of ministry of health and ministry of agriculture in relation to zoonotic diseases reporting and control, and inter-sectoral collaboration in Jordan. Methods: Jordanian ministerial infrastructures, mechanisms, legislation, responsibilities, programs, and activities related to zoonotic disease detection and reporting were reviewed. Publicly available information of national government agencies drawn from annual reports, official websites, program guidelines, advisories, minutes of meetings, and inter-ministerial communications were also reviewed. In addition, personal interviews with official, subject matter experts, and technical representatives of ministries of health and agriculture were conducted to gather, clarify, and verify data. Results: Although the current infrastructure of both Ministries is organized and well established, several gaps and challenges were identified. The regulations to judge and manage zoonotic disease notification and reporting need to be revised to become thorough and systematic between the two ministries. In addition, inter-ministerial zoonotic diseases reporting and notification between the two ministries is inconsistent, which may prevent reporting zoonotic disease in timely manner. The current reporting and surveillance system is closer to an indicator- based surveillance system which limits the ability to investigate and report new emerging zoonotic diseases. The capability to diagnose zoonotic diseases is not always present, and diagnostic tests used to confirm zoonotic diseases are not readily available or done for all diseases. Conclusions: Development of information sharing agreement between ministries, regulations and band y laws that organize and manage zoonotic disease notification and reporting in Jordan is needed. It is essential to review and modify the current reporting and surveillance systems at the two ministries to allow reporting new emerging zoonotic diseases. Capacity building in terms of zoonotic disease diagnosis remains vital for a One Health approach implementation in Jordan.